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As His Church Prays, Weakened Pope Nears Death

VATICAN CITY, April 1 - Pope John Paul II hovered near death on Friday. The Vatican announced that his breathing had become shallow and some organs had begun to fail.

"This evening or this night, Christ opens the door to the pope," Bishop Angelo Comastri, the vicar of the Vatican, told the tens of thousands of faithful who converged on St. Peter's Square.

The square was ablaze in floodlights and huge television screens for a prayer service within sight of the light still burning at 11 p.m. in the pope's third-story apartment. The mood was mournful, with Italians and pilgrims crying and kneeling on the square's cobblestones.

"When the father suffers, the children suffer," Bishop Comastri said. "When the father dies, the children kneel and pray and tell him of their affection and their gratitude."

Worry for the pope -- and some degree of relief that he might soon be released from his painful years of illness -- overflowed around the world: in Jerusalem, New York and London; in Latin America and Asia, where the church has grown strongly under his reign; in Poland, where he was born in 1920 as Karol Wojtyla.

A medical bulletin released about 7 p.m., as a Mass began at St. John Lateran for his health, said the pope's blood pressure was suffering a "gradual worsening" and his "breathing has become shallow." It noted problems with his cardiovascular system and his kidneys.

"The biological parameters are notably compromised," said the statement, issued by the pope's spokesman, Dr. Joaquín Navarro-Valls.

In the dry medical language, it was the grimmest bulletin from the Vatican since the pope's health began its swift downward spiral.

With his kidneys giving out, virtually all of the pope's major organ systems are now compromised.

The information that his breathing was shallow, without any mention of a plan to remedy the problem, suggested that death was near, and that the pope and his doctors had decided against putting him on a breathing machine. While ventilators can rescue failing lungs, and dialysis can tide over kidneys, there is little doctors can do when all organs are giving out at once.

The pope, who has suffered from severe breathing problems related to his advanced Parkinson's disease for the past two months, had not previously had any particular trouble with his heart or urinary system. But at the end of life, when one system fails, others tend to follow.

Prof. Luigi Allegra, head of cardiopulmonary medicine at the Polyclinic Hospital in Milan, explained: "First you have one organ down, and you can recover. Then another fails. Now the pope has three or four systems compromised: lungs, heart, urinary, muscle. The situation is really critical."

But the latest Vatican bulletin suggested that the pope remained conscious, as he apparently has all along. "The Holy Father -- with visible participation -- is joining in the continual prayers of those assisting him," the statement said.

Echoing an outpouring of emotion for the 84-year-old pope around the world, the normally restrained Dr. Navarro-Valls nearly broke into tears earlier in the day when asked his own feelings at the prospect of the death of John Paul II, the 264th pope, a once vital and athletic man whose transforming papacy began in October 1978. The pope received the sacrament for the sick and dying on Thursday.

"Certainly this is an image that I haven't seen before in these 26 years," Dr. Navarro-Valls told reporters on Friday, his voice breaking up. "The pope is lucid and extraordinarily serene, but of course he is having trouble breathing."

The pope, who decided not to be readmitted to the hospital, was visited in his apartment at the Vatican by several of the most powerful cardinals in the Roman Catholic church, some of whom will run the church after the pope dies and are often mentioned as candidates to succeed him.

They include Cardinal Angelo Sodano, the secretary of state and No.2 official in the Vatican; Cardinal Joseph Ratzinger, the influential and conservative head of church doctrinal affairs; and Cardinal Camillo Ruini, the vicar of Rome, who will be charged with announcing the pope's death to the world.

He was also visited by Archbishop Leonardo Sandri, the deputy secretary of state, who has read many of the pope's messages in the later stages of his sickness; Cardinal Edmund C. Szoka, a Polish-American former archbishop of Detroit who now runs the Vatican City government; and two other influential archbishops, Giovanni Lajolo, the Vatican's foreign minister, and Paolo Sardi, deputy to the Vatican chamberlain, who will run the Holy See after John Paul II dies until a new pope is chosen.

"He was perfectly conscious," Cardinal Szoka told WXYZ-TV in Detroit. "He recognized me immediately, and I knelt by his bed and prayed for him. When I was leaving, I gave him a blessing and he tried to bless himself with his hand."

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Cardinal Ruini told an Italian television station that the Pope was "profoundly serene and lucid."

Up through the early evening, the Vatican's repeated mentioning of his consciousness may not have been accidental. Earlier on Friday, the Vatican reacted with unusual swiftness to deny as "rubbish" an Italian news service report that the pope had slipped into a coma.

This is, in fact, one of the most sensitive questions surrounding the pope's illness: While the death of the pope has long been expected, many experts note that Roman Catholic canon law makes no provisions for what happens if a pope falls into a coma. Apart from a signed letter from the pope spelling out his wishes -- which many Vatican experts say they assume exists -- there is no convention for who would hold power, how power would be transferred or even who would make medical decisions for an unconscious pope.

In Gdansk, Poland, Lech Walesa, the former leader of the Solidarity trade union, gave credit to Pope John Paul II -- as many other historians have -- for encouraging the Polish resistance to Soviet-backed rule in the early 1980's, a struggle that ultimately led to the fall of Communism in Eastern Europe.

"If today I was to be asked to weigh the merits of all sides," Mr. Walesa told Agence France-Presse, "I would say half was due to John Paul II and 30 percent to the Polish people and Solidarity. Margaret Thatcher, Ronald Reagan, Helmut Kohl, Boris Yeltsin and Mikhail Gorbachev did the rest."

Inside St. Peter's, a special Mass was said for the pope's health on Friday afternoon, and the Mass at St. John Lateran was attended by Prime Minister Silvio Berlusconi and his political rival, Romano Prodi. At the mass at St. John Lateran, Cardinal Ruini suggested that the pope's death was imminent. The pope, he said, "already sees and touches the Lord -- he is already united with our soul Savior."

At St. Peter's, Msgr. Dario Rezza recalled in a sermon the pope's wide travels, to about 130 countries, to spread the church's message.

"Today the entire world is at the pope's bedside, praying with the fervent desire that this traveler who has visited so much of the world remain with us," he said. "The world has understood the value of this father, who has worried about global peace and well-being, who has brought the gospel to people who are suffering."

Outside the basilica early this afternoon, Eileen Malloy, 38, a Scottish tourist, said she had seen the pope on his visit to Scotland in 1984, and said it was typical of the energy he brought to the church that she found herself on her feet with tens of thousands of other young people cheering him like a rock star.

"I didn't know that I would do that, because it wasn't cool," she said. Now, she said, "it's sad to see him as an old man," and she said it would be a blessing for his suffering to end.

While the pope has been declining for years, suffering from the increasingly debilitating effects of Parkinson's disease, his health has been in a steep decline since Feb.1, when he was rushed to the Gemelli Hospital in Rome suffering from flu, fever and serious breathing problems.

He was discharged nine days later, but readmitted with similar symptoms on Feb. 24, when doctors inserted a breathing tube into his windpipe to ease the breathing problems. He was discharged from his second stay nearly three weeks ago, but was too ill to take part in any of the Holy Week ceremonies with the exception of Easter Sunday. Even then, though, no words came out of his mouth when he tried to give his traditional Easter blessing from the window of his apartment on St. Peter's.

He tried again -- and also failed -- in another appearance from his window on Wednesday. Hours later on Wednesday, the Vatican announced that doctors had threaded a feeding tube from his nose to his stomach because he had not been getting enough nutrition.

Despite the variety of treatments he has accepted in the past two months, like many chronically ill patients at the end of life, the pope would have had to decide for himself when he had enough. The Vatican report of the pope's shallow breathing suggested, for example, that he had chosen not to go on a respirator.

"One can withdraw burdensome therapy when an individual makes the decision that the burdens outweigh the benefits," said Dr. Myles Sheehan, a physician and Jesuit medical ethicist at Loyola University Medical Center in Chicago.

To Catholics, "our life is tremendously important," Dr. Sheehan said. "But the real goal is the eternal life, this supernatural calling."

JOHN PAUL II: THE OVERVIEW Correction: April 16, 2005, Saturday A front-page article on April 2 about the scene at the Vatican as Pope John Paul II hovered near death rendered a word incorrectly in a passage from a special Mass celebrated in Italian for the pope by Cardinal Camillo Ruini, the vicar of Rome. He said the pope was "already united with our sole Savior" -- not "soul Savior."

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A version of this article appears in print on April 2, 2005, on Page A00001 of the National edition with the headline: JOHN PAUL II: THE OVERVIEW; As His Church Prays, Weakened Pope Nears Death. Order Reprints|Today's Paper|Subscribe